What is the treatment for a wound on the penis?

Treatment of Penile Wounds

The treatment of a penile wound depends critically on the mechanism of injury: traumatic wounds (penetrating, fracture, bite) require urgent surgical exploration and repair, while superficial wounds can be managed with local wound care, topical antibiotics, and close observation. 1

Initial Assessment and Critical Considerations

All penile wounds require evaluation for concomitant urethral injury if there is blood at the urethral meatus, gross hematuria, or inability to void. 1 This evaluation should include retrograde urethrogram or urethroscopy—neither method is superior, and the choice depends on equipment availability and timing. 1, 2

Key Clinical Pitfalls

• Never apply caustic agents (podophyllin, TCA, BCA) to areas with open lesions or wounds as this can cause severe tissue damage and systemic toxicity. 1
• Human bite wounds to the penis are particularly dangerous and can progress to necrotizing fasciitis if not treated aggressively. 3, 4

Management Algorithm by Wound Type

Traumatic/Penetrating Wounds

Penetrating penile injuries should undergo surgical exploration in nearly all cases except the most superficial wounds. 1, 2

• Perform bilateral corporal exploration with artificial erection to identify tunical defects and prevent long-term erectile dysfunction and penile deformity. 5, 2
• Primary repair of corporal defects should be performed with absorbable suture. 1
• Retrograde urethrogram is indicated in 79% of penetrating cases and diagnostic in 92% when urethral injury is present. 2
• Primary urethral repair is preferred (67% of cases) over urinary diversion when feasible. 2

Penile Fracture

Patients presenting with penile ecchymosis, swelling, cracking/snapping sound during intercourse, and immediate detumescence should undergo prompt surgical exploration and repair. 1

• Expose the injured corpus cavernosum through either a ventral midline or circumcision incision. 1
• Perform tunical repair with absorbable suture at time of presentation to improve long-term outcomes. 1
• Ultrasound may be used in equivocal cases, but if diagnosis remains uncertain, proceed with surgical exploration. 1
• Concomitant urethral injury occurs in 10-22% of cases, particularly with bilateral corporal fractures. 1

Bite Wounds (Human or Animal)

Human bite wounds to the penis require aggressive management due to high risk of polymicrobial infection and potential progression to Fournier's gangrene. 3, 4

• Initiate broad-spectrum empiric antibiotics immediately. 4
• Perform aggressive local wound care with irrigation and debridement. 4
• Maintain careful observation for necrotizing complications. 4
• Delayed presentation significantly increases infection risk—patients often do not seek timely medical attention. 4

Superficial Wounds and Post-Surgical Care

For non-traumatic superficial wounds or post-surgical wounds:

• Clean the affected area and apply topical antibiotic (bacitracin) 1-3 times daily to a small area (equal to fingertip surface area). 6
• May be covered with sterile bandage. 6
• For surgical wounds, use tubular elastic gauze dressing that provides consistent pressure without vascular occlusion and accommodates stents or catheters. 7

Extensive Tissue Loss or Scrotal Involvement

For extensive genital skin loss, perform exploration and limited debridement of clearly non-viable tissue only. 8

• Wound management options include: 8
  • Gauze dressings with frequent changes
  • Silver sulfadiazine or topical antibiotic with occlusive dressing
  • Negative pressure dressings
• If testicular rupture is suspected (scrotal ecchymosis, swelling, loss of testicular contour on ultrasound), perform immediate surgical exploration with tunical closure or orchiectomy if non-salvageable. 8

When Conservative Management is Appropriate

Conservative management with local wound care and topical antibiotics is only appropriate for:

• Truly superficial wounds with no concern for deeper structure involvement 6
• Post-operative wounds after definitive surgical repair 7
• Wounds without signs of infection, urethral involvement, or corporal injury 2

The threshold for surgical exploration should be low—when in doubt, explore surgically rather than risk missed injuries that lead to long-term erectile dysfunction, penile deformity, or life-threatening infection. 1, 2